Older Age May Improve Immunotherapy Outcomes in Melanoma

Surabhi Dangi-Garimella, PhD

According to a new study published in JAMA Dermatology, older patients had better clinical outcomes than their younger comparator cohort following treatment with newer immunotherapy agents for their advanced melanoma.

The single-center retrospective study in France included 92 patients who received treatment for their advanced melanoma in the Lyon Sud Hospital between January 2007 and February 2016. Treating agents include ipilimumab (a cytotoxic T-lymphocyte–associated antigen 4 inhibitor), nivolumab (a programmed cell death-1, PD-1, inhibitor), or pembrolizumab (a programmed death ligand-1 inhibitor), for a total of 120 lines of treatment.

Nearly 60% of patients were 65 years or younger (24 [44%] were female; mean [SD] age, 48.1 [12.5] years) and the remaining 38 were over 65 years (12 [34%] were female; mean [SD] age, 74.8 [6.9] years). The mean duration of follow-up was 12.5 months at treatment initiation.

The authors found that progression-free survival (PFS) was better in the older population: mean PFS was determined to be 4.8 months in the older cohort, compared with 3.4 months in the younger cohort (P = .04) following univariate analysis. Additionally, while overall survival (OS) had not been reached in the older population at the time of analysis, the mean OS in the younger cohort was 10.1 months (P = .009). This was more obvious in the patients who were treated with the PD-1 inhibitor, nivolumab.

With respect to immune-related adverse (irAEs) events, which are commonly observed with these agents, the authors did not observe any difference in the most common irAEs between the 2 cohorts, although older patients had more comorbidities. However, older patients more frequently developed meningitis and immunologic nephritis. 

“Age might be associated with a better clinical outcome after treatment with immunotherapy in the real-life setting,” the authors write. They do, however, recommend the need for additional studies to confirm their findings

Perier-Muzet M, Gatt E, Péron J, et al. Association of immunotherapy with overall survival in elderly patients with melanoma [published online December 6, 2017]. JAMA Dermatol. doi:10.1001/jamadermatol.2017.4584.
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